The end of AIDS?

My supervisor messaged me: “ABC news right now – the end of AIDS as a public health issue.”  Fairfax was reporting it too:

AIDS epidemic ‘over’ in Australia, say peak bodies

Australia’s peak AIDS organisations and scientists have announced an end to the AIDS epidemic, as the country joins the few nations in the world to have beaten the syndrome.

The number of annual cases of AIDS diagnoses is now so small, top researchers and the Australian Federation of AIDS Organisations [AFAO] have declared the public health issue to be over.  (Saimi Jeong, The Age 10 July 2016)

In blog posts and feature articles for some time now, I’ve been arguing that media framings, policy-making and popular understandings of HIV have lagged behind reality, holding onto notions of the ‘AIDS crisis’ and HIV as a deadly disease.

These ‘zombie notions’ impede sensible policy-making around prevention, such as the removal of outdated HIV-specific laws, and public funding for pre-exposure prophylaxis — medication that protects HIV-negative people from infection during condomless sex.

lazarus

Gary Dowsett first conceptualised ‘post-AIDS’ thinking among gay men in 1996.  In 2004, at a plenary session of the HHARD and HIV Educators’ conferences, I described myself as ‘pre-AIDS’ — born in 1981, coming out to myself in the mid-90s, the ‘AIDS crisis’ was over in the gay community before I ever joined it, and I’d had to reconstruct an understanding of what it had meant for the people around me.  More recently, cultural studies scholar and critic Dion Kagan wrote his PhD on ‘post-crisis’ meaning-making around HIV, along with a stellar series of columns exploring this theme in The Lifted Brow.

I understand the messaging from AFAO and celebrity scientist Prof Sharon Lewin in this context.  At first I wondered what it was about.  I think there are three things going on:

  • The number of people dying from AIDS, rather than dying with HIV, is now so low it violates statistical conventions against reporting cell sizes under 5.
  • AFAO might have wanted to shift the media and policy narrative and ‘claim a win’ to count against what’s starting to look like the inevitable failure of ‘Ending HIV‘.
  • Australia wanted an ‘announceable’ going into the AIDS2016 conference in Durban.

(Update: AFAO’s CEO Darryl O’Donnell did a great job challenging outdated narratives on ABC Radio National Breakfast this morning — you can listen to the interview here.)

A number of people have expressed concern to me that this announcement obscures the reality of ongoing, smaller AIDS crises in particular groups, including migrants and refugees, especially those who lack access to Medicare, and Aboriginal communities.

Since 1996 we no longer focus on deaths from AIDS nor even AIDS diagnoses — early diagnosis and treatment are the ballgame. People with late diagnosis, defined as a t-cell count below 350 per millilitre of blood, have elevated lifetime risk of serious illness, including cardiovascular events like heart attack, even after they start on treatment.

Update:  The figure below shows the heterosexual communities in which late diagnosis is common. Spoiler alert — it’s all of them.  And the personal impact of infection will be far greater for people are living in communities where outdated notions of HIV still predominate; where strategies to tackle stigma and discrimination are nascent or non-existent; and that in many cases haven’t yet developed cultures of care to support treatment and wellbeing.

Screenshot 2016-07-11 08.05.47

Source: Kirby Institute, Annual Surveillance Report 2015 p51 (pdf)

In other health issues, such as cancer screening, the identification of lower rates of screening in specific communities compared to the Victorian population average has been used to target them for additional funding and recruitment initiatives.  But the danger is always that small clusters get swept under the carpet, protected from identifiability by that convention against reporting cell sizes under 5.

My concern about this messaging is that it depends on policy-makers understanding that AIDS is not a journalistic synonym for HIV.

If they don’t, this message will look like a green light to ‘mainstream HIV’ — ditching peer based services and funding hospitals, nurses, social workers and MPH grads to ‘mop up’.  That would be more expensive than community-based services, but it would restore what the health system views as the natural way of doing things — top down, expert-led.

Bernard Gardiner, a PhD scholar working on a qualitative longitudinal study of aging, place and social isolation among people living with HIV in Queensland, and a respected elder of the Victorian gay community response to AIDS, puts it this way:

I think this is careless. This takes the pressure off Public Health officers working for Government, who see psycho-social support services for long-term survivors as unnecessary ‘hand-holding’ that Gov should not fund. It also disguises the reality that some long-term survivors struggle for quality of life with depression, multiple co-morbidities, cognitive issues, cancers/heart/renal issues, and poverty, and feel somewhat abandoned by the biomedical 90/90/90 focus.

Once upon a time a shift like this would have been thoroughly debated among the AFAO membership and communicated to affected communities via community media.  This would have provided an opportunity to prepare for the secondary messaging that will be necessary to make sure this message doesn’t backfire.  We live in interesting times.

Digital quarantine? Grindr considers HIV filter

A colleague from UMontréal, David Myles, posted these Grindr screencaps in a group for researchers interested in hook-up apps.  Turns out Grindr is surveying at least some of its members to find out how they feel about filtering other members by HIV status.

For a long time it has been possible on sites like BarebackRT and Manhunt to search by HIV status — for example, to facilitate serosorting as a way of partially reducing the risk of HIV transmission during unprotected sex, before PrEP came along.  Users could also save searches, so if they ticked every box except HIV-positive, they could construct their own de facto anti-HIV filters.

But it is a completely different ballgame for the makers of an app to build in a feature that effectively facilitates digital quarantine of people living with HIV.

It signals that HIV stigma is normal and rational.

Now, it could be said that people who use the filter are effectively isolating themselves from people living with HIV — reducing the likelihood of encounters where stigma is enacted in the form of verbal abuse and discrimination.  (Here’s one I prepared earlier.)

But Grindr filters, to the best of my knowledge, only stop matching profiles from appearing on the ‘grid’ — the display cabinet or catalogue of other users.

Would the HIV filter work differently, making that user invisible to others whose HIV status didn’t match their preferences — more like an automatic block function?

If it did, and enough HIV-negative people used it, it really would constitute a form of digital quarantine that leaves people with HIV outcast and invisible.

If it didn’t, it might set the scene for even more stigmatising encounters, fuelled by filter users’ surprise (and probably anger) that someone with HIV had contacted them.

Alternatively, they might assume that everyone who contacted them was HIV-negative, and the problematic implications of that assumption are well-known.

Grindr needs to cut this out.  Right now.  We are living in an era of effective prevention medication.  We should not be reinforcing categories that are used in less effective strategies for prevention.

‘Ending AIDS in a generation’

I’ve been openly critical of the rhetoric in global HIV/AIDS policy around ‘ending HIV’.  For instance, at the MSM Global Forum pre-conference in Melbourne before AIDS2014, when US global AIDS ambassador Debbie Birx exhorted queer and trans people to ‘run a little harder’ towards the goal of ending AIDS in a generation.  This would be a little easier if so many queer and trans people around the world weren’t also running for their lives.

For many AIDS activists, the timing of the Orlando massacre was particularly painful, coming hard on the heels of the UN High Level Meeting on AIDS, where ‘key populations’ of queer and trans people, people who inject drugs and sex workers were actively excluded from deliberations and barely mentioned in the final document.

Laurel Sprague noted one paragraph in particular as a masterpiece of international policy double-speak.  I’ve highlighted the competing voices in different colours:

Reaffirm the sovereign rights of Member States, as enshrined in the Charter of the United Nations, and the need for all countries to implement the commitments and pledges in the present Declaration consistent with national laws, national development priorities and international human rights;

So the ‘run a little bit harder’ rhetoric shifts responsibility away from states and onto communities, making it sound like they’re not working hard enough to end HIV.

There is another problem with the ‘ending HIV’ rhetoric, as seen in this quote from an interview with Bill Gates, one of the largest funders of global HIV prevention:

There’s a few things where you get a slogan like “AIDS-free generation.” … I wish that were more likely. Truthfully, because we don’t have a vaccine, and the prophylactic tools, the compliance of those things has been very poor. We actually run a risk that the next generation will have more AIDS than previous generations.

It’s a story with mostly positive elements, but if you say simplistically we are on the path toward an AIDS-free generation, no, we’re not. We need more R&D, more tools. And if you’re not careful, if you overpromise, you do get this fatigue, and then, even when you still need the resources, people don’t come in.

The experience of the global effort to eradicate polio tells us that even if a preventative vaccine for HIV were discovered tomorrow, it would still take a multi-generation effort to eradicate HIV.  Consistent with Bruce Link and Jo Phelan’s fundamental causes of disease (FCD) model, we’d expect to see rich countries achieve pretty high vaccine coverage early on, and poorer countries (and disadvantaged social groups) taking a lot longer.  The crux of the FCD model is lack of access to what Link and Phelan call flexible resources like money, knowledge, literacy, and social status.

But I want to acknowledge that – at least in Australia – the ‘ending HIV’ rhetoric was in large part an intervention by canny policy entrepreneurs who sensed the winds of change in the early days of the global financial crisis, and knew to anticipate the damage that could be caused by social conservatives having a ‘good crisis’, using austerity discourse to justify huge cuts to social services and welfare.  The extended election campaign we’re having in Australia has created space for unions and social policy researchers and social services peak bodies to tell the story of the billion dollars in cuts under Abbott.

Although the HIV sector is by no means unscathed, with genuinely community-based peaks like Anwernekenhe National HIV Alliance for Aboriginal and Torres Strait Islander peoples getting completely de-funded, and the Australian Federation of AIDS Organisations losing funding for its education program to two of its own member orgs (!), my sense is that things could have been so much worse.

This is a hard one to prove — the counterfactual is a hypothetical what could have been.  But having Australia’s largest state, New South Wales, commit to an Ending HIV strategy, campaign, and program of rapid testing services and early treatment, helped keep HIV prevention on the policy agenda.  So while the science of the ‘ending HIV’ claim is questionable, that was never really the point.

YEAH, nah.

There’s a campaign doing the rounds on twitter to #SaveYEAH, referring to an organisation in my field called Youth Empowerment Against HIV/AIDS.

This weekend, Jill Stark wrote about the campaign in The Sunday Age, and the paper also ran an editorial on it, both linking the ‘defunding’ of YEAH to attacks by the Christian right wing of the Liberal-National government on the Safe Schools Coalition Australia.

In fact, as a member of the Ministerial Advisory Committee on BBV and Sexually Transmitted Infections, YEAH CEO Alischa Ross most likely knew in advance that the entire funding stream was being replaced.  An ‘Invitation to Apply for Funding H1516G007’ for a new stream was released in November 2015, which included $1.3m for web, app and social media resources targeted people under 30 about sexual health.

Although it knew about the new funding arrangements from November 2015, the #SaveYEAH campaign did not begin until an initial tweet on 14 April 2016.  Rather than a ‘defunding’ it seems more likely that YEAH was unsuccessful in applying for funding under the new stream.

The article quotes Anne Mitchell and Michael Carr-Gregg (who is not, to my knowledge, an expert on sexual health promotion) claiming the funding decision is ideological:

They claim YEAH (Youth Empowerment Against HIV/AIDS) is the latest victim of an ideological agenda pushed by conservatives who believe teaching students about sex and sexuality from an early age is dangerous.

“There’s a lot of kowtowing to right-wing activists at the moment and you’d have to say that defunding of YEAH is part of that agenda too,” Anne Mitchell, emeritus professor at La Trobe University and one of Australia’s leading authorities on sexual health and education, said. (source)

This does not stand up to factual scrutiny.  The decision to replace YEAH’s face-to-face approach with one based on social media was clearly taken months before George Christensen MP began attacking the Safe Schools Coalition in February 2016.

The Age editorial went further:

The Coalition plans to slash the program’s $450,000 annual budget and instead make information available online.

How sadly ironic. The way modern digital technology has increased pressure on young people especially to engage in unwanted sexual behaviour is an important part of the reason the community needs to have more open discussion about sex and directly confront any misapprehension.

(…)

Given the recent furore over slashing the Safe Schools Coalition – an initiative to stamp out discrimination against LGBTI students – it is hard to escape the conclusion the government is deliberately pandering to the conservative wing of Liberal party in this raid on funds. (source)

Apart from the timing being wrong, spending $900K more funding on sexual health promotion via apps, the web and social media is not consistent with the picture being painted here of a government afraid of talking to young people about sex.

Typical of The Age, it can’t see the contradiction in arguing ‘modern digital technology has increased pressure on young people especially to engage in unwanted sexual behaviour’ while dismissing interventions that engage in the same spaces to address those problems.

For advice on the value of digital technologies in promoting young people’s health, The Age could have asked one Michael Carr-Gregg, who is Managing Director of the Young and Well CRC and developed its Certificate in Young People’s Mental Health and Digital Technology.

We should not fund YEAH

It’s a matter of numbers and reach.


How many young people aged 15-30 are there in Australia?
2,464,966 (ABS estimate 30 June 2013, table 7)

How many new young people enter that cohort every year?
144,617 (ABS estimate 30 June 2013, table 7)

Young people reached by YEAH in 2015
10,000 ‘face-to-face’ (Jill Stark, The Age 23 April 2016)


These figures from their 2015 Annual Report show the cost-effectiveness of this program:

Screenshot 2016-04-25 12.55.47Screenshot 2016-04-25 12.55.27Screenshot 2016-04-25 12.55.00

Unless the 62 workshops had 161 participants each, it seems like the 10,000 ‘face-to-face’ contacts — the number quoted in Jill Stark’s article — includes young people reached via Facebook, Instagram, e-newsletters etc.  If so, the majority of YEAH’s outreach to young people was via online social media.  If not, we paid $456K for YEAH to conduct 62 workshops, at a cost of $7,358 each.

Sidebar:  I am absolutely mystified by the claim in YEAH’s annual report that it spoke to ‘50,000’ and ‘82,000’ young people in 2014 to ascertain their views about its participation in the Triple J regional music festival, Groovin’ the Moo.

Screenshot 2016-04-25 16.52.39

Is this an argument for funding YEAH to reach more people?  No.  The problem isn’t a lack of resources, it’s that their service model is misguided to begin with. The problem is partly how the organisation was historically focussed and partly the failure of its CEO, Alischa Ross, to step down from hands-on management of the organisation when she was no longer a young person.

First, the history of YEAH. As HIV/AIDS infection rates increased in the early 2000s, a number of different ‘moral entrepreneurs’ saw their opportunity.  In November 2007 the ABC reported:

MARK COLVIN: In the last few years especially, it appears the issue of AIDS has gradually dropped down the agenda, both for politicians and the community.

Infection rates in Australia are rising and there are concerns that the young generation is ignorant or complacent about the dangers of HIV.

Youth affairs reporter, Michael Turtle.

MICHARL TURTLE: This year, it’s estimated about a thousand Australians will be diagnosed with HIV for the first time. That’s an increase of about 30 per cent from the year 2000, when 763 people were found to have been infected.

After almost two decades of containment, HIV has begun to get the better of the community again. (source)

Ross framed YEAH as a pre-emptive response to a forthcoming epidemic of HIV/AIDS among young people:

MICHARL TURTLE: Alischa Ross is the CEO of the group Youth Empowerment Against HIV/AIDS.

She also sees the prevention of the virus as a priority for all ages and all sexualities. And she’s warning that it may not be long before it becomes a big problem amongst the new generation.

ALISCHA ROSS: We know that Sexually Transmitted Infections amongst the young people are spreading like wildfire. This is the same behaviour that results in spread of HIV, so it is a matter of time until we see HIV spreading amongst young sexually-active teenagers.

MICHARL TURTLE: Ms Ross is calling for a renewed focus from governments on education and awareness. She thinks HIV needs to be talked about more in schools and in the community.

ALISCHA ROSS: If we’re talking about this as a preventable disease, which it is, and we’re meaning prevention in true sense of the word, which is to stop something from happening in the first place, then I don’t think our response to prevention, when it comes to young people, should mean that we wait to see a problem emerge. (source)

By that point — 26 years into the AIDS crisis — it was pretty clear that Australia was not going to see what’s known as a generalised epidemic where more than 1% of the heterosexual population are living with HIV.  Instead we have what’s known as concentrated epidemics — predominantly among gay men;  due to prompt and proactive work by sex workers and people who inject drugs, HIV prevalence in those two groups in Australia is incredibly low compared to other countries.

In that interview, Ross argues we should respond to something of which there was zero evidence — a mainstream HIV epidemic ‘in the new generation’.  The heterosexual focus here is subtle, but distinctive:  if you are targeting gay men, it’s pretty inefficient to go through ‘schools and the community’.

In this early phase of YEAH’s development one particular phrase got a workout:

Through the development of YEAH (Youth Empowerment Against HIV/AIDS) Alischa’s focus has been educating young people from across diverse communities, advocating the message, ‘HIV/AIDS is an issues that affects everyone‘. (source)

Alischa Ross had no educational training and this is apparent from the incredibly dense ‘student fact sheets‘ and teaching materials YEAH was promoting at the time.  I remember being concerned that the information provided was confused:

A retrovirus moves in the reverse direction to the natural cycle of the body’s own cells enabling this type of virus to bypass check points that would usually prevent the integration of foreign materials entering human cells.

The body relies upon these check points in the cell cycle to regulate disease control. HIV’s ability to bypass this allows it to integrate into the body’s own system and take over white cells by inserting its own genetic material into the body’s T cells and the new DNA re-programs the cell to destroy the immune system. (source)

In the late 2000s the Australian Government launched an ‘STIs are spreading fast’ campaign and YEAH obtained funding to promote STI awareness among young people.  This led to a shift in its messaging to emphasise a sense of crisis around STI.  In a presentation to the 2012 CSRH conference, Ross and Felix Scholtz argued:

In the past 3 years Australia has seen a 20% increase in the rate of STIs diagnosed amongst people aged 15–29 years. With more than three quarters of nationally reported STIs occurring amongst young people we must find new ways to effectively communicate and articulate in a meaningful way with young people, many of whom have limited or inaccurate knowledge of sexual health risks and how to prevent poor sexual health outcomes.

This project investigates the effectiveness of people aged 17–29 trained in HIV/STI peer-education, to deliver sexual health promotion activities at a national regional music festival to determine if there is an evidence base for scaling-up youth-led sexual health promotion.

Using peer education and social marketing activities, the project facilitated the promotion of positive sexual health messages to 85,000 young people in five regional centres. Using qualitative analysis of the perceptions and experiences of participants, it’s argued that methods involving young people are more likely to be effective in directly impacting young people’s behaviour.

The analysis contributes to understanding best practices to empower young people to take control of their sexual health. The findings support increased investment in policy and peer-based programs that put young people’s leadership at the centre of national responses to youth sexual health. (source

The abstract uses relative percentages (‘a 20% increase’) and proportions (‘three quarters’) to suggest a sense of crisis around STIs in young people.

However, diagnosing more STIs doesn’t automatically indicate an increase in transmission of STIs: it can mean more people getting tested, either seeking it out because of awareness or being proactively offered testing by doctors.  It can also mean the same base rate of infection multiplied by an increased rate of sexual encounters and partner change (or concurrency).  My point here is that it’s an incredibly crude figure and careful analysis and further research are required before drawing conclusions from it.

Secondly, there’s an implicit claim that STI diagnoses among young people are disproportionate. This in fact reflects patterns of sexual and romantic partnerships in Australian culture: many people see their twenties as a time for exploration and form longer-term partnerships in later life.

There are other problems here.  Like the way a funded project is presented as a research initiative (‘investigates the effectiveness of’).  Or the weasel words used around its absurd estimation of its claimed reach (‘facilitated the promotion of … messages to 85,000 young people’).  Or the mismatch of constructivist research methods and data type (‘qualitative analysis of the perceptions and experiences of participants’) to assess a probabilistic question (‘likely to be effective in directly impacting young people’s behaviour’).

But most of all it conflates policy participation with service delivery.  I agree with its call for ‘increased investment in policy and peer-based programs that put young people’s leadership at the centre of national responses to youth sexual health’.  And that’s why I don’t support the #SaveYEAH campaign — because YEAH, as an organisation, is not configured in a way that reflects best practice in youth leadership and engagement.

Achieving effective representation of young people doesn’t require a model where young people deliver all the services.  It requires an engagement structure and practices that reaches a diverse array of young people, listens to them on an ongoing basis (this rules out focus groups and online surveys), and then translates their feedback into influence on policy-making and service delivery by other agencies, so that young people have better experiences of more sensitive and relevant education, clinical service provision, etc.

Effective policy advocacy achieves a multiplier effect: by targeting policy and the establishment of best practices, it influences a wider array of services and actors who in turn influence the daily lives of a much, much wider audience than direct service provision can ever hope to reach.

Even if you ‘promote messages’ about sexual health to young people, if they can’t get condoms, or see a trans-friendly psychologist, or get sexual health care which includes a rectal swab, then the message isn’t helping anyone.

Of course, YEAH would argue that it does this advocacy work as well.  But when its CEO Alischa Ross turns up at a policy forum instead of an actual young person and gets called out for speaking for Youth Empowerment Against HIV/AIDS (Inc) instead of empowering actual young people to participate in making policy, that doesn’t work.

Ross was born in 1980 and in a 2009 book chapter she wrote:

Screenshot 2016-04-25 17.07.50.png

(source, p207)

There is a norm among youth-led organisations of CEOs ‘stepping up and stepping back’, or in the case of Oaktree Foundation, requiring their CEO to resign at age 26. Organisations that don’t take this approach need to be transparent about their adherence to best practices in youth participation, engagement and leadership. That is a governance issue, because it profoundly affects the organisation’s credibility in funding and advocacy.  YEAH needs to have a good hard think about those issues as it casts around for new funding.

Leaving twitter

This is just a post to confirm I’m shutting my main twitter account @dnmstrategic down on May the 1st.  I follow a bit over 2,000 people, who consistently post thoughtful comments and interesting content, and I’m coming up on 100,000 tweets, both indicators that this is a substantial investment that I don’t walk away from lightly.

If we’ve been in contact on twitter I’d love to stay in touch with you.

I do have a ‘bolthole’ twitter account and I’m planning to add all the accounts I followed to a list on that account — but it’s set on private so I won’t be able to respond to your tweets.

Why take such a step?  A couple of reasons.

One is just that it takes up a lot of time and attention — energy I need to channel into writing articles and PhD work.  Normally I get a lot of value from twitter in return, e.g. interesting conversations, learning about new publications, opportunities and events.

But even with all the privilege I have as an educated able-bodied white middle-class man, twitter’s tendency to pile-ons is a negative externality I’m no longer willing to deal with.

In particular, last month I was the target of a pile-on orchestrated by a guy named Dennis Relojo, a contractor employed by the University of Warwick’s “Piirus” social network for research collaborators.  I asked him to follow twitter conventions for addressing one-to-one tweets, so that my timeline wouldn’t fill up with his attempts to promote the network.  His response was to invite his 10,000 followers to pile on.  They contacted my workplace, signed up my work e-mail up to pornographic mailing lists, dished out homophobic abuse, etc.  And I knew right then: I am done with this.

I also want to acknowledge an incident a while back where the fuckup was mine completely — where I continued the thread of a DM conversation about why I’d blocked a young activist via public tweets.  In the early days of twitter it was more common to do this – to use twitter conversation to discuss other tweeters’ use of twitter to establish (or debate) what the emerging norms were.  But you can’t do that with 2,000 followers; that’s like gossiping into a megaphone.  And twitter had recently changed the block function, so that the person I’d blocked still got notified of my tweets, and they were rightly scathing.

So, in short, I no longer feel secure using twitter.  Its interface and systemic function don’t afford effective ways to deal with pile-ons.  The block function is broken.  Lists are incredibly painful to populate and use.  And speaking as a hot-headed loud-mouth, it is stressful knowing anything stupid I say gets amplified so drastically.  I’d rather use media and formats that invite and afford what Mark Pearson calls, in the Buddhist tradition, ‘right speech‘.

Imagining prevention: the case of violence against women

A few years ago I was working at a research centre and a senior researcher had some money to develop a grant application.  I’d moved there from about ten years in practice in health promotion and I was still figuring out how research practice actually works. So when I was given the brief to do a literature review on what works in addressing racism and preventing violence against women, I didn’t think to ask for a narrower scope.

Alaska_Floodplain_1902

Alaskan flood plain (A.H. Brooks, USGS 1902)

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Telstra and Catholic bullying

Yesterday brought the news that Telstra has quietly withdrawn its support for the marriage equality campaign, following a threat by the Catholic Archdiocese of Sydney to take their business elsewhere.

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St Mary’s Cathedral Sydney (Sacha Fernandez, Creative Commons License)

My own contract with Telstra is tied up in personal business: my phone is on a discounted friends-and-family plan via my ‘ex-boyfrang’ who worked for them.

It’s in my name and I signed and pay for it, but recently, when I went to get a SIM replacement, the Telstra store told me their records show I don’t have authority ‘on’ (over) the account.

To get it changed, I had to get back in contact with my ex-partner.  I needed him to co-sign a form authorising a ‘change of ownership’.  I’m lucky that my ex is a reasonable guy, but someone leaving an abusive partner who refused to sign would be liable to continue paying for the phone.

So I e-mailed the form… and then nothing happened.  After ten days I followed up by e-mail, then twitter, who asked me to try Telstra’s 24/7 live chat, who (after 30 minutes) asked me to call Billing.

My experience on that call demonstrates why it’s a problem that Telstra caved-in to Catholic bullying on its support for a movement to recognise the equal value of same gender partnerships.

I am not fussed about gay marriage.  My politics are queer, I’m single, when partnered I prefer open relationships, and with David Warner, I view marriage as the top rung of a hierarchy of social status that denigrates single people, sexually adventurous people, and people who do sex work.

On the phone I spoke to a worker in a call centre in the Philippines who could not have been more keen to help me out.  They were incredibly courteous.

But the Philippines is one of the world’s most Catholic countries, and they kept tripping over the fact my ex-partner is male.  They kept calling him ‘she’ and correcting themselves.  They asked if the transfer was from a female friend who is also listed on his account.  That great signifier of heterosexual discomfort, ‘your friend’, got a workout.

Highlighting Telstra’s systemic problems, they reported that the transfer request had been cancelled on their system without any reason being recorded.  When I offered to send the co-signed form to restart the process, they said I’d need to try again with a new form.  When I threatened a complaint to the Ombudsman, they called my ex to get permission.

This is one argument for same gender marriage: it provides access to legislated procedures to manage the division of property and the disentanglement of legal affairs at the end of a relationship.  Without these, gay people depend on institutional employees’ discretion.

Catholic doctrine treats sex and romantic love as things that should only be allowed in the context of a single monogamous lifelong relationship.

That’s why the Church opposes divorce, and why there is such a debate over access to Communion without annulment – a theological procedure that declares the marriage never existed, for the purposes of ‘clearing the slate’.

It’s fine for Catholic people to believe that, but there is no reason why their views should be reflected in the policy of the state — governing people whose lives and views and relationships are different, including non-Catholics, divorced people, and people who love people of the same gender.

The action of the Catholic Archdiocese of Sydney shows that when they can’t, by strength of argument and belief, persuade others to adopt their views, they are willing to throw their weight around, as a sizeable consumer and provider of services, to impose those views on the community.

This is why Catholic providers shouldn’t be running homeless shelters or youth services: under exemptions to anti-discrimination legislation, they are permitted to (and routinely do) exclude same gender attracted, sex and gender diverse people from care.

Those exemptions must be overturned.

And as soon as I ‘own’ the phone account I signed and pay for, I’ll be leaving Telstra.